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Obstetrics and Gynaecology > Antenatal care > Flashcards

Antenatal care Flashcards

1
Q

Important antenatal discussions

A 
US
Exercise, diet, smoking, alcohol
Pelvic floor exercises
Optimal fetal positioning
Perineal massage
Signs of labour
When to come in
Hospital access
Pain management
3rd stage labour management
Vitamin K and Hepatitis B
Length of stay
EMS
Breastfeeding
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2
Q

Investigations required antenatal

A

Booking
24-28 weeks
34-36 weeks
40 weeks

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3
Q

Investigations at booking visit

A 
Blood group
pap smear
Hb
Antibodies
RPR
Hep B.Hep C
Rubella
HIV
Syphillis
MSU, GBS
Gonorrhea, chlamydia
Iron
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4
Q

Investigations at 24-28 weeks

A

Hb
Antibodies
OGTT
Urine

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5
Q

Investigations at 34-36 weeks

A

Hb
Antibodies
RPR

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6
Q

Investigations at 40 weeks

A

Hb

Antibodies

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7
Q

Examination requirements at each antenatal visit

A 
BP
Edema, reflexes, clonus
Abdominal->gestation calculation and size
Presentation
1/5 palpable
Liquor
FHS
Fetal movement
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8
Q

Antenatal visit schedule

A

4/52 to 28
2/52 to 36
1/52 to delivery

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9
Q

Common complaints in pregnancy, cause and treatment

A 
Morning sickness
Carpal tunnel syndrome
Vaginal discharge
Pelvic pain
Heartburn
Varicose veins
Hemorrhoids
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10
Q

History for each subsequent visit

A 
General health
Fetal well being
Leakage of fluid
Vaginal bleeding
Contractions/abdominal pain
Preeclampsia-->headache, visual disturbance, RUQ pain
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11
Q

What is biophysical profile

A

Combination of non-stress test and US

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12
Q

Components of BPP

A
  1. NST–>variation of fetal heart
  2. Breathing: >1 episode of rhythmic breathing movement of 30sec or more in 30 min
  3. Movement >3 discrete body/limb within 30 minutes
  4. Muscle tone: >1 episode of extension with return to flexion or opening/closing of hand
  5. Determination of amniotic fluid index
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13
Q

Normal amniotic fluid volume

A

800-1000ml at 36-37 weeks

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14
Q

In T2 what does the AFI represent

A

Fetal urine output

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15
Q

If AFI low in T2 what does it indicate

A

Uteroplacental dysfunction-> -ve oxygenation, fetus preferentially shunts blood to brain and heart->kidney underperfused= -ve urine output= -ve amniotic fluid

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16
Q

What value of AFI is adequate, oliohydramnios and polyhydramnios

A 
Adequate= 5cm
Oliohydramnios= 25 cm
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17
Q

Most common cause of oligohydramnios

A

Ruptured membranes

IUGR in 60%

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18
Q

Causes of polyhydramnios

A 
Fetal malformation (anencephaly, esophageal atresia), genetic
Maternal diabetes
Multiple gestation
Fetal anemia
Viruses
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19
Q

What are complications of polyhydramnios

A

Uterine overdistension->preterm, PROM, fetal malposition, uterine atony

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20
Q

Caffeine

A

In coffee, tea, chocolate, soft drink
>300mg may +risk of abortion
Insomnia, regurgitation, reflux, urine frequence

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21
Q

Exercise and CI

A

No evidence to decrease activity
If regular before should continue
Relieves stress, anxiety, +self esteem and shortens labor
If +time in supine, should avoid in T2/3
Should stop if experience oxygen deprivation–>extreme fatigue, dizzy, SOB

CI to exercise:
IUGR
Persistent vaginal bleeding
Incompetent cervix
Risks for preterm
ROM
HTN, pre/eclampsia
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22
Q

Nausea and vomiting

A

Common, 50% in T1
If severe- dehydration, electrolyte imbalan
Mild->avoid spicy/fatty foods. Small frequent meals. Inhale peppermint. Drink ginger teas.
Severe->IVF (with glucose, to reduce the ketosis which can exacerbate the nausea), supplements, antihistaine, metoclopramide.

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23
Q

Heartburn

A 
30%
Relaxation of LES
Eliminate spicy/acidic
Small, frequent
Sit up
Reduce liquid with meal
Sleep with head elevated
Liquid antacids, H2 inhibitors
Reduce amount of food before bed
24
Q

Constipation

A

Common
+fiber, +liquids, Metamucil
Avoid enemas, strong cathartics and laxatives.

25
Q

Varicosities

A

Common in lower extremeties and vulva
Chronic pain, thrombophlebitis
Avoid garments that restrict in the knee/upper leg
Support stocking
+periods of rest with elevation of lower extremities

26
Q

Hemorrhoids

A 
Cool sitz baths
Stool softners
\+fluid and fiber
Hemorrhoidal ointment
Topical anaesthetic spray/steroid cream
Most improve after delivery
Hemorrhoidectomy can be performed safely in pregnancy if required
27
Q

Leg cramps

A

50%

Massage and stretching

28
Q

Back pain

A 
Progressive
Minimise time standing
Wear support belt
Paracetamol
Exercises to strengthen back
Supportive shoes
Gentle back massage
29
Q

Round ligament pain

A

Sharp, bilateral, unilateral groin pain
+In T2
Get on hands and knees with head on floor and buttocks in the air

30
Q

Sexual intercourse and contraindications

A

No restrictions in a normal pregnancy
Nipple stimulation, penetration and orgasm can +oxytocin and prostaglandin= uterine contractions

CI: ruptured membrane, placenta previa, preterm labor

31
Q

Employment

A

Should avoid activities which+ risk of falls/trauma

32
Q

Travel

A

Best time is T2->past risk of miscarriage in T1, and not yet preterm labor of T3
Stretch out for 10 minutes every 2 hours
Bring copy of medical record
Wear seat belt in car
No additional risk with air travel
Usual travel precautions depending on destination

33
Q

When should a pregnant woman contact her obstetrician

A

Vaginal bleeding
Leakage
Rhythmic abdominal cramping/back pain >6hr does not improve with hydration/lying supine/changing postition
Progressive and prolonged abdominal pain
Progressive vomiting, can’t hold down any food/water for 24 hours
Seizure
Progressive severe headache, visual chages, generalised edema
Pronounced decrease in frequency/intensity of fetal movements

34
Q

Goals of first antenatal visit

A

Health of mother and fetus
Identify conditions affected by pregnancy
Identify factors that affect pregnancy
Determine the model of care

35
Q

History in first antenatal visit

A

Past obstetric history->pregnancies, delivery, ectopics, miscarriage, SVB, C section
Gynaecological history: LMP, pap smears, contraception
Calculate EDD
FHx->medical conditions, congenital, HTN, diabetes
MHx, medications, supplements
SHx, relations
Allergies
Investigations
Psychological

36
Q

Booking examination

A 
General inspection- demeanour, tatoos, scars, rashes, pallor, jaundice
Spine- scoliosis, kyphosis
Vitals- BP
Thyroid
CVS- heart murmus
Respiratory
Breast examination
Abdominal examination- inspect, palpate and auscultate
Bimanual not usually requires
Legs- varicose and edema
37
Q

Where is fetal heart heard early and late in pregnancy

A

Early- midline of uterus

Late- position of anterior shoulder

38
Q

Risk factors identifiable in pregnant woman

A 
Age > 35
Evidence of post partum psychiatric
Previous pregnancy/birthing issues
Medical history->DM, HTN, renal/heart
Drug use
Obesity
Short
Parity when >3
39
Q

Advice to pregnant women on onset of labour

A

Regular painful contractions from small of back to lower abdomen->come to hospital when contractions every 5-10 minutes
ROM + gush of fluid->come to the hospital
Bloody/mucus show may not be labour, if with contractions contact midwife, go to delivery unit.
Best to come in if think in labour

40
Q

General advice for healthy pregnancy

A 
Diet, exercise, weight gain
Smoking, alcohol, drugs
Iron and folate
Get someone else to change cat litter tray
Avoid soft cheeses, unpasteurised, pate
41
Q

Up to 10, 10-14, 20 weeks gestation, how accurate is the CRL

A

+/- 5 days 20 weeks

42
Q

Most accurate measure for gestation assessment in second trimester and third trimester

A

In second- BPD

In third- femur

43
Q

What to arrange at first visit

A 
Confirm pregnancy
Dating USS
Routine bloods
Shared care arrangements- refer to hospital
CFTS
44
Q

When should urine be checked

A

When +BP

45
Q

When can fetal parts be palpated

A

From 28 weeks

46
Q

When does fetal head descent become relevant

A

When >36 weeks

47
Q

When is Rh status rechecked

A

at 26-28 weeks

48
Q

When is anti-D given

A

28 weeks and 34 weeks

49
Q

When is Hb and syphillis repeated

A

36 weeks

50
Q

When is IOL offered post dates

A

41-42 weeks

51
Q

Woman presents pregnant, what do you tell them

A

Congratulate
Ask if well
Where she can book for the birth will be determined by health and progress, medical cover

52
Q

History from woman presenting pregnanct

A

Full history->obstetric, gynae, medical/surgical, social, family
LMP, cycle, contraception
Calculate EDD: add 9 months and seven days to LMP if regular
Feelings about the pregnancy

53
Q

Examination for woman presenting pregnant

A 
General- BP
CV
Respiratory
Thyroid
Breast
Abdominal
Vaginal?
54
Q

When to book into hospital

A

As soon as possible
Decision about care
Given hand held record
Over investigations, USS, first trimester screening

55
Q

Arrangements following first visit

A

To return after investigations

Monitor general health

Obstetrics and Gynaecology (45 decks)

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